Provider Demographics
NPI:1568434405
Name:ANGELO, TIFFANY ELYSE (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ELYSE
Last Name:ANGELO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2109
Mailing Address - Country:US
Mailing Address - Phone:631-759-0328
Mailing Address - Fax:
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH-75910207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology